Good governance in the New Partnership for Africa’s Development (NEPAD): a public administration perspective

The object of this study is good governance, the context for its consideration is the New Partnership for Africa’s Development (NEPAD), and the disciplinary perspective from which it is considered is Public Administration. Good governance is a conceptual problematique. It is multi-dimensional, value-laden, trans-contextual and nebulous. The question of what good governance means is a subject of contestation. Good governance is used in NEPAD as a principle without the attempt to clarify its meaning at the conceptual level. Much of the existing body of scholarship on NEPAD also considers good governance largely as a principle rather than a concept. This erroneously presupposes unanimity on its meaning. The African leadership is divided on what good governance means in the context of NEPAD. In this regard scholarship largely fails to provide an intellectual solution. The extent of complexity of the concept in the study lies in the fact that the context of its consideration [NEPAD] is itself a subject of contestation whereas the disciplinary perspective [Public Administration] from which it is considered has not yet reached a consensus with itself about its theoretical base. Against this background the question that the study asks is, what does the concept good governance in the context of NEPAD mean for Public Administration? The study examines this question to make a contribution towards a better insight into, and broadening of, the body of scientific knowledge by engaging in conceptual, theoretical and philosophical studies to understand good governance in the context of NEPAD and determine its meaning for Public Administration. The study finds that the paradigm of engagement in the existing body of literature is framed in the binary logic, which is rooted in realist epistemology or positivism. This approach to scientific discourse is limited in dealing with complex conceptual, theoretical and philosophical questions. The study develops, as a contribution to science, an alternative epistemological framework from which good governance in the context of NEPAD could be understood. Such epistemological framework is, for the purpose of this study, termed the contingent co-existence of opposites. It is used to conceptualise good governance in the context of NEPAD and determine its meaning for Public Administration.Public Administration and ManagementD. Litt. et Phil. (Public Administration

Actinium-225-PSMA radioligand therapy of metastatic castration-resistant prostate cancer (WARMTH Act): a multicentre, retrospective study.

BACKGROUND Actinium-225 (225Ac) prostate-specific membrane antigen (PSMA) radioligand therapy (RLT) is a novel therapy for metastatic castration-resistant prostate cancer (mCRPC). We aimed to report the safety and antitumour activity of 225Ac-PSMA RLT of mCRPC in a large cohort of patients treated at multiple centres across the world. METHODS This retrospective study included patients treated at seven centres in Australia, India, Germany, and South Africa. We pooled data of consecutive patients of any age and Eastern Cooperative Oncology Group performance status with histopathologically confirmed adenocarcinoma of the prostate who were treated with one or more cycles of 8 MBq 225Ac-PSMA RLT administered intravenously for mCRPC. Previous lines of mCRPC treatment included taxane-based chemotherapy, androgen-receptor-axis inhibitors, lutetium-177 (177Lu) PSMA RLT, and radium-223 dichloride. The primary outcomes were overall survival and progression-free survival. FINDINGS Between Jan 1, 2016, and May 31, 2023, 488 men with mCRPC received 1174 cycles of 225Ac-PSMA RLT (median two cycles, IQR 2-4). The mean age of the patients was 68·1 years (SD 8·8), and the median baseline prostate-specific antigen was 169·5 ng/mL (IQR 34·6-519·8). Previous lines of treatment were docetaxel in 324 (66%) patients, cabazitaxel in 103 (21%) patients, abiraterone in 191 (39%) patients, enzalutamide in 188 (39%) patients, 177Lu-PSMA RLT in 154 (32%) patients, and radium-223 dichloride in 18 (4%) patients. The median follow-up duration was 9·0 months (IQR 5·0-17·5). The median overall survival was 15·5 months (95% CI 13·4-18·3) and median progression-free survival was 7·9 months (6·8-8·9). In 347 (71%) of 488 patients, information regarding treatment-induced xerostomia was available, and 236 (68%) of the 347 patients reported xerostomia after the first cycle of 225Ac-PSMA RLT. All patients who received more than seven cycles of 225Ac-PSMA RLT reported xerostomia. Grade 3 or higher anaemia occurred in 64 (13%) of 488 patients, leukopenia in 19 (4%), thrombocytopenia in 32 (7%), and renal toxicity in 22 (5%). No serious adverse events or treatment-related deaths were recorded. INTERPRETATION 225Ac-PSMA RLT shows a substantial antitumour effect in mCRPC and represents a viable therapy option in patients treated with previous lines of approved agents. Xerostomia is a common side-effect. Severe bone marrow and renal toxicity are less common adverse events. FUNDING None